Local Treatment in Patients Presenting with Stage IVc Head and Neck Squamous Cell Carcinoma

Head and neck squamous cell carcinoma patient presenting with distant metastasis stage IVc is rare, concerning 4.7% of patients in our experience. There are many questions unsolved regarding standard systemic treatment administration, as well as the feasibility and benefit of local treatment. However, there ais a strong rationale, in terms of tumor biology and empirical treatments, to treat the primary tumor in a curative setting. In the Institute Gustave Roussy experience, upfront curative treatment has been possible to be administered in 17% of patients. Median overall survival was 39 months, with 1-year and 5-year overall survival rates of 68% and 40.7%, respectively. In 70% of patients, no upfront curative treatment was feasible, thus a systemic therapy was initiated. 37% of these patients, so 26% of stage IVc patients, had a complete response to chemotherapy first, and could undergo a subsequent curative locoregional treatment. Median survival was 17 months for complete responders and 7 months for others, with 1-year and 5-year verall survival rates of 68.3% vs. 40.3% and 15.8 vs. 3.6%, respectively. 13% of stage IVc patients could not receive any oncological treatment and followed best supportive care. Median overall survival was 2 months, with 1-year and 5-year overall survival rates of 23% and 0%. In conclusion, 43% of stage IVc patients could receive a locoregional treatment in a curative intent. With the improvement of systemic therapy results, the development of immunotherapy treatments, and increased survival of patients with metastatic disease, preservation of quality of life should be considered a major criterion for treatment decision-making.